HomeMy WebLinkAboutContract 53040-R1CSC No. 53040-R1
CITY OF FORT WORTH
FIRST RENEWAL OF AGREEMENT
WHEREAS, the City of Fort Worth, ("City"), and William J. Schultz Inc. dba Circle C
Constiuction Company, authorized to do business in Texas ("Contractor"), entered into that
certain ORIGINAL AGREEMENT (City Secretary # 53040, M&C 19-0162) for the PROJECT
generally described as: Sewer Main Extensions, Replacements & Relocations Contract 2019 and
WHEREAS, the ORIGINAL AGREEMENT may be renewed up to 2 times as provided
by M&C 19-0162; and
WHEREAS, The City and Contractor desire to renew the ORIGINAL AGREEMENT for
an additional term at the same price, said FIRST RENEWAL is available in the budget of the
Water and Sewer Capital Projects Fund, as appropriated in Ordinance # 22393-09-2016.
NOW, THEREFORE, it is agreed by the City and Contractor as follows:
Article I
The Scope of Services as set forth in the ORIGINAL AGREEMENT has not changed.
Article II
The Contractor's compensation shall be in the amount up to $ 1,000,000.00. The Term of
this renewal agreement shall be for one year, effective as of the effective date or the expenditure
of the funding, whichever occurs first.
Article III
There are no other changes to any other terms or conditions of the ORIGINAL
AGREEMENT.
First Renewal of Agreement
Circle C Construction Company
City Project No. 102196
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EXECUTED by each party's duly authorized repres�ntative and EFFECTIVE as of the date
subscribed by the City's designated CiTy lvlanager.
, William J. Schultz, Inc. dba
City of Fort Worth Circle C Conshuction Company
��� B�Z���L
Dana Burghdoff(Apr20,20 735 CDT�
Dana BLu•ghdoff
Assistant City Manager
Apr20,2021
DATE:
� ss�
Name Teresa S. Skelly
Title President
DATE: /z - 7- t a z o
APPROVAL RECOMMENDED:
`:l �_•,s. � �"�� � .
Clu7s Harder, P.E.
Director, Water Department
APPROVED AS TO FORM AND LEGALITY:
�Z'�
Douglas W. Black
Sr. Assistant City Attorney
Contract Compliance Manager
M&C: 19-0162
Date: 9/17/2019
Form 1295 No. 2020-643179
By signing I acknowledge that I am the person responsible for the monitoring and administration
of this contract, including ensuring all performance and reporting requirements.
A�IU��AX�
Lawrence Hami ton, P.E.
Senior Professional Engineer
ATTEST:
�����
Mary J. Kayser
City Secretaiy
First Renewal of Agreement
Circle C Constiuction Company
City Project No. 102196
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OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
ACITY COUNCIL AGEND
DATE: 9/17/2019 REFERENCE
NO..
CODE: C TYPE:
**M&C 19- LOG NAME: 60SSERRRCON2019-
0162 CIRCLEC
CONSENT PUBLIC NO
HEARING:
FC1 RT �4�'U RT H
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SUBJECT: Authorize Execution of a Contract with William J. Schultz, Inc., dba Circle C Construction
Company, in the Amount of $1,000,000.00, for Sanitary Sewer Main Extensions,
Replacements and Relocations Contract 2019, Provide for Project Costs and
Contingencies for a Project Amount of $1,300,000.00 and Adopt Appropriation Ordinance
(ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
1. Adopt the attached appropriation ordinance increasing estimated receipts and
appropriations in the Water Capital Projects Fund from available funds in the amount of
$1,300,000.00; and
2. Authorize execution of a contract with William J. Schultz, Inc., dba Circle C Construction
Company, in the amount of $1,000,000.00, for Sanitary Sewer Main Extensions,
Replacements and Relocations Contract 2019, with up to two renewals. (City Project No.
102196)
DISCUSSION:
The work to be performed under this contract consists of extending, replacing and/or relocating
sewer mains, service lines, and other pertinent construction required to upgrade existing sanitary
sewer infrastructure or as required to provide sewer service to individual customers or developers.
While funding for this project comes from the Water and Sewer Capital Projects Fund, the Water
Department issues work orders to the Contractor after payment of applicable estimated costs by
the Customer and/or Developer.
The bid documents included a stipulation that the total quantities listed may not reflect actual
quantities and that the amount budgeted for the project is $1,000,000.00. Final payments will be
made based on actual measured quantities. The bid documents also included a stipulation giving
the City the option to renew (subject to appropriated funding) this contract two times under the
same terms, conditions and unit prices.
In addition to the contract amount, $300,000.00 is required for project management, real property
acquisitions, survey, material testing and inspection.
This project will have no impact on the Water Department's operating budget when completed.
Construction is expected to start November 2019 and be completed when the contract amount is
exhausted.
M/WBE OFFICE — William J. Schultz, Inc., dba Circle C Construction Company is in compliance
with the City's BDE Ordinance by committing to zero percent MBE participation and documenting
good faith effort. William J. Schultz, Inc. dba Circle C Construction Company identified several
subcontracting and supplier opportunities. However, the firms contacted in the areas identified did
not respond or did not submit the lowest bids. The City's MBE goal on this project is six percent.
The project is located in ALL COUNCIL DISTRICTS.
The appropriation is for funding of the FY2019 CIP.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations and adoption of
the attached appropriation ordinance, funds will be available in the Fiscal Year 2019 capital budget,
as appropriated, of the Water and Sewer Capital Projects Fund. The Fiscal Year 2019 Water and
Sewer Operating Fund budget includes appropriations of $35,856,873.00 within the Wastewater
Operating Budget for the purpose of providing Pay-As-You-Go funding for Sewer Capital projects.
After this transfer for Fiscal Year 2019, the balance will be $12,348,027.00.
Appropriations for the Sanitary Sewer Main Extensions, Replacements and Relocations Contract
2019 project are depicted below:
Fund
W&S Capital
Projects Fund -
56002
Existing Additional Project Total*
Appropriations Appropriations
$0.00 $1,300,000.00 $1,300,000.00
Project Total $0.00 $1,300,000.00 $1,300,000.00
*Numbers rounded for presentation purposes.
TO
�Fund Departmen�unt�roject Program Activity Budget � Reference # Amount
� ID � ID Year_ (Chartfield 2� �
FROM
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID Year Chartfield 2
Submitted for City Manager's Office by_
Originating Department Head:
Additional Information Contact:
ATTACHMENTS
Dana Burghdoff (8018)
Chris Harder (5020)
Adolfo Lopez (7829)
60SSERRRCON2019-CIRCLEC 56002 A019.docx
Ordinance No.
AN ORDINANCE INCREASING RECEIPTS AND APPROPRIATIONS IN THE WATER &
SEWER CAPITAL PROJECTS FUND IN THE AMOUNT OF $1,300,000.00,
TRANSFERRED FROM AVAILABLE FUNDS IN THE WATER & SEWER FUND, FOR THE
PURPOSE OF FUNDING THE SANITARY SEWER MAIN EXTENSIONS,
REPLACEMENTS AND RELOCATIONS CONTRACT 2019 PROJECT (CITY PROJECT
NO. 102196); PROVIDING FOR A SEVERABILITY CLAUSE; MAKING THIS ORDINANCE
CUMULATIVE OF PRIOR ORDINANCES; REPEALING ALL ORDINANCES IN CONFLICT
HEREWITH; AND PROVIDING AN EFFECTIVE DATE.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF FORT WORTH, TEXAS:
SECTION 1.
That in addition to those amounts allocated to the various City departments for Fiscal Year 2020-2021 in the
Budget of the City Manager, there shall also be increased receipts and appropriations in the Water & Sewer
Capital Projects Fund in the amount of $1,300,000.00, transferred from available funds in the Water & Sewer
Fund, for the purpose of funding the Sanitary Sewer Main Extensions, Replacements And Relocations
Contract 2019 project (City Project No. 102196).
SECTION 2.
That should any portion, section or part of a section of this ordinance be declared invalid, inoperative or void
for any reason by a court of competent jurisdiction, such decision, opinion orjudgment shall in no way impair
the remaining portions, sections, or parts of sections of this ordinance, which said remaining provisions shall
be and remain in full force and effect.
SECTION 3.
That this ordinance shall be cumulative of Ordinance 24446-09-2020 and all other ordinances and
appropriations amending the same except in those instances where the provisions of this ordinance are in
direct conflict with such other ordinances and appropriations, in which instance said conflicting provisions of
said prior ordinances and appropriations are hereby expressly repealed.
SECTION 4.
This ordinance shall take effect upon adoption.
APPROVED AS TO FORM AND LEGALITY:
Douglas W Black
Sr Assistant City Attorney
Mary J. Kayser
City Secretary
ADOPTED AND EFFECTIVE:
OD 6I 13 -1
PERFORMANCE BOND
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16 i�IEREAS, the Principal has entered into a certain writteii coiltract with the City
17 awarded flie day of ��� ; 20_, whicli Contract is hereby referred to alid
18 made a part hereof for all purposes as if fully set fot�th herein, to furnish all materials, eqixipmeni
19 iabor and other accessories de�ned by Iaw, in fhe prosecution of the Work, including any Change
20 O�•dei�s, as provided for in said Conn•aci designatec� as
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23 NOW, THEREFORE, tlie condition of t11is obligation is such tllat if the said Principal
24 shall faithfuily perform it obligations under the Contract and shall in aIl respects duly and
25 faithfully perfoz•m the Work, including Change Orders, under the Coiltract, according to the pIans,
26 specificatio�is, and contract documents therein refen•ed to, and as well during any period of
27 extension of ti�e Contract that may be granted an the part of the City, then this obiigation shall b�
28 and become null and void, othelwvise to remain in fitil force and eifect.
BOND NO. TXC613309
SECTION �0 b1 13
PERFORMANCE BOND
TgIE STATE OF TEXAS §
§ KNOW ALL BY TH�SE PRESENT�:
COUNTY OF TARRAN'T §
Tiiat we, William J. Schultz, Inc. dba Circle C Construction Company , kno�t�n as
"Principal" lierein and Merchants Bonding Company (Mutual) , a corporate
surety(sureties, rf more than ai�e) duly authorized tn do business in #he State of Texas, icnown as
"Surety" herein (wI�ether one or �nol•e), are held az�d firtnly bound unto the City of Foi�t Wortil, a
mt�t�icipal coi•poi•atiaji ct•ealed pu�suaiit to tlie la��s of Texas, known as "City" lierein, ui the penal
stim of, Qne Million Dolla►•s ($ 1,400,000.00 ),
lawfitl rnoney of the United States, to be paid in Fot�t Worth, Tat�rant Cotanty, Teaas fortlie
payment oiwhich sum weil and truly to be made, we bind ourselves, our heirs, executnrs,
admixzistrators, successors and assigns, jointly and severally, �irmIy by these presents.
I=ITi ��' I�E�'+1:E4�jAL, -."iE��I;R: tv1AII`�� F_,�:TFNSIt�IR'S, REPI,r'��E�i�NTS c'�. REL���`['=I�N�
C'i�N`�I�?lC`i' �Oi�), C'1'1'� 1��1�C
29 PROVIDED FURTHER, tliat if any legat action be �iled on this Boiid, venue shall lie in
. 30 Tarrant County, Texas or the United States Dist��ict Court for tlie Northern District of Texas, Far�
31 Worth Division.
CI?'Y OF PORT W()RTH MSERR2019, i�' ReneFYal
STANDARll CONSTI2UCTION SPF,CiFIGATIO\ DOCUMENTS CityProjectNa Id2196
Revised duly l, 20l ]
00 61 13 - 2
PERFORtvfANCE BQND
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l This bond is inade aud executed in compliai�ce with flie provisiotis of Chaptei• 2253 of tlie
2 TeYas Goveinlnent Code, as ame�ided, and all liabilities on this bond shall be deternlined ii�
3 accordance with flie provisions of said statue.
4 IN W�TNE55 WHERECIF, the Principai aud the Surety have SIGNED and SEAL.ED
5 this inst��ument by duly authorized agents and officers oji this the day of
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ATTEST:
^ G < <
(�" 1 cAo,�� L�C,��
(Principal} Secretary�ichele S. L for
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Wihless as ta Principal
'��'r� ��� �: 9� . _
Wimess as to Surety John A. Miller
PRTNCTPAL:
William J. Schultz, Inc. dba
Circle C Construction Company
�Y: % a �s"�'�
S ignahu•e
Teresa S. Skelly, President
Name and Title
Address: P. O. Box 40328
Fort Worth, TX 76�40
SI.JRETY:
Merchants din Com �an Mutual�
;
BY:
ignaftire
Sheryl A. Klutts, AttorneV-in-Fact
Name and Title
Address: 6700 Westown Parkway
West Des Moines, IA 50266
Telephone Number: 1-800-678-8171
*Note; If signed by an officer of the Surety Company, there must �ie on file a eertified extract
fi•om the by-laws showing that this �erson has authority to sigu such obligation. If
SUrety's physical address rs different from its mailing address, both must be provided.
The date of the bond shall iiot be pi•ior to the date the Contract is awarded.
CITY OF FORT WORTH
STANDARD CONSTitUCTION SPECIPICATION DOCUMENTS
Revised Ttily 1, 201 I
MSERIt2019, 1� 12enewal
City Project No. 102196
oo6t ta-i
PA7'NfENT BOND
Page 1 0£2
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ib WHEREAS, Principal lias en#ered into a certain vvritten Cont�•act with Ci#y, awartlecl the
17 day of ��� � , 20 , which Contract is liereby refened to and
18 made a part hereof for all purposes as if fully set forth herein, to furi�ish all materials, equipment,
19 labor and ather accessoxies as de�nec� by Iaw, in the prosecution of`the Work as provided fo�� in
20 said Cantraci and designated as
2i FIRS'�' RE;i�i�bti'A:L -� SE'+J��'ER MAIN T;�T�;3�IStUI'�1�. R�PLAC�ivi�;3�ITS, & R�I,t�C;r�TiC7NS
22 C;C��t`1'I�1�.�T2U19, i:,i'�I li?219ti
23 1�TOW, THEREFORE; THE CONDITION OF THIS OBLIGATION is such that if
24 Principa.l shali pay ali monies owing to any (and a(1} paytnent bond bene#"iciary (as defuied 'ul
25 Chapter 2253 oftlie Texas Governmen# Code, as amended) in the p�osecution of the Work under
26 the Contract, then tl�is nbligation sha11 be and become nurl and void; otherwise to xemain in full
27 force and effect.
28 This bond is made and executed in complianee with the provisions of Chapter 2253 of tlie
29 Texas Government Code, as amended, and all liabilities on this boz�d shall be determined in
30 accordance with the pi•oviszons of said statute.
THE STATE OF TEXAS
CnUNTY OF TAI2I3 t�NT
That we, William J. Schultz, Inc. dba Circle C Construction Company , lcuawn as
"Principal" herein, and Merchants Bonding Company (Mutual) , a
corporate sui•ety (snreties), duly autnorized io do busuiess in the State of Texas, knawn as
"Surety" hereiii (t�llether one or more), are held and fu•mly bound �.rnta the City of Fort Worth, a
rnunicipal corporation created pursuant to tl�e laws of the State of Texas, kno�vn as "City" herein;
in tlie penal sum of One Millio� Dotlars ($ 1,OOO,d00.00�, lawfirl
iliQney of the Usrifed States, to be paid in Fart Wortli, Tai�rant Couiity, Te�as, for the payment of
which sum wetl and t�uly be n�ade, we bind narselv�s, o�u heirs, executors, administrators,
successors and assi�,nis, jaintly and severally, �rm�y hy these presents:
BOND NO. TXC613309
SECTION OU S1 14
PAYMENT BOND
§
§ KNOW ALL BY T�ICSE PRCSENTS;
§
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CITY OF E'nRT WORTH
S1'ANI�ARD CONSTRIICTION SPECIFICAI'IQN POCUMENTS
Kevised July l, 2011
MSERR2019,1nReneival
City Project No. 102196
0061 14-2
PAYMENTBOND
Page 2 �f 2
1 IN WITN�SS WII�REOF, the Principal and Surety have each SIGNED and SEALED
2 this instrument by duly autharized agents and afficers an this the day of
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ATTEST:
PRINCIPAL:
William J. Schultz, Inc. dba
Circle C Construction Com an
BY: �.�c.t�o a 5�.�
Signature
Teresa S. Skelly, President
Name and Title
Address; P. O. Box 40328
Fort Worth. TX 76140
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(Principal) Secretary Michele . Lankford
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Wihiess as to Priucipal
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SURETY:
Merchants B n ` Company (Mutual)
ATTEST: BY:
Signa re
Sheryl A. Klutts, Attorney-in-Fact
(Surety) Secr�tary Name and Title
� ,� , e�,� � Addtess. �7pp We,stnwn Parkwa�i
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.__ _ WP.St nP.S Mnines, IA .r,��FFi
Witness as to Surety John A. Miller
Telephone Number: 1-800-678-8171
Note: If signed by an o�cer of the Surety, there must be on �le a certified extract from the
bylaws showing that tliis person has authority to sign such obligation. If Siu•ety's physical
address is different from its mailing address, both must be provided.
The date of the bond shall not be prior to the date the Contj•act is awarded.
END OF SECTION
C1TY OF FORT WORTH
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS
Revised July 1, 2011
MSEItR2019, 1" Renewal
City ProjectNo, 102I96
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006119-1.
MAIi�iTENANCE BOND
Page ( of 3
BOND NO. TXC613309
�ECTYOIY 00 61 19
MEIINTENANCE BOND
THE STATE OF TEXAS §
§ KNOW ALL BY THESE PRESENTS;
COUIVTY OF TAI2I2ANT §
Thatwe William J. Schultz, Inc. dba Circle C Construction Company , Icnorvi� as
"Principal" herein and _ Merchants Bonding Company (Mutualj , a eorpoi�ate �urety
(sureties, if more tl�an one) duly authoi•ized to cia business iii the State of Texas, Imown as
"Surety" herein (wliether ane or• more), are heid ai�d fu�mly bound u�ito tlie �ity of Fort Wortl�, a
municipal corporation created put•suant to tlie laws of the State of Te�as, known as "City" hereiu,
in the sum of One Million Dollars ($' I,OOO,OOO.00�, lawful money
of ihe Unifed States, ta be paid `ui Foz-t Wo�-�h, Tarrant Coanty, Texas, for paymen# af which sum.
well and t��uiy be made unto the City and its succassors, we bind ourselves, oui' heiis; executors;
administratars; successors and assigns, jointly and severally, firmly by these presents:.
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WH�I2EAS, the Principal has entered into a certain written contzact wit12 ths City awarded
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the day of , ZO_, which Contract is hereby
referred to and a made part hereof for ali purposes as iffully set fort�i herein, to futnish all
materials, equipmer�t labor and other accessories as defined by law; in the pi�osecution of tbe
�ork, including any VJork resulting fram a duly authorizec� Change OrdeY (collectively he�•ein,
tha "Work") as provided for iii said contracf and designated as
I'iR�T REl'�1E1rUAL=S�'�V�R i�<�Ii�i EXTENSIO�iS RI'sPI,�1�E�ENT�< & RELLiC�TIOI�i�'
Ct�NTRAC;T Z� I� GPN 'I O� i 9C, at�d
2'7 WHEREA�, :Priilcipal binds itself to uss such materials and to so construct the Work in
28 accordance with tlie plans, speci�cations and Contract Documez�ts that the Work is and will
29 remain free from defects in matexials or workmans�ip foi� and dw•ing the pez�iod of two �2} years
30 after the date of Final Acceptance of the Work by the City {�`Nlainienance PeriQd"j; and
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32 WHEIZEAS, Principal buids itself to repair or reconstruct the �7Vork in whole or in part
33 upon receiving notice from the City af the need therefar at any time within the \!faintenanc�
34 Pei•iod.
CITl' QS' FOR'I' WO1tTF-I
STANDARI) CONSTKtJC1'ION SPECIFICATION DflC(JMENTS
Reviseci July 1, 2011
MSfiRIt2919, 1�`Rene�4al
City Project. No.102196
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00 61 19 - 2
MAINTENANC� BOND
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NOW THEREF4R�, the coiidition of this ohtigation is such that if Principal shall
remedy any defective Work, for which tiinely notice was provided by City, to a completion
satisfactory to the City, then this obligation shall become null and void; otherwise to reznaui in
fall foree and effect.
PROVIDED, HO'WEVER, if Frincipal shali fail so to repair or reconst�uct arzy tiine�y
noticed defective Worlc, it is agteed that the Ciiymay cause any and all such ciefective Work to
be repaired and/ar reconstruc#ed with all associated costs thereof being bo��ne by the Principal and
the Sitrety under this Maintenance bond; and
PROVIDED FIJIZ7CHER, that if any legal action be fiied on fhis Bond, venue sliall lie in
Tarrant County, Texas or• the United States District Court for the Nortl�ern District of Texas, Fort
Woi�th Division; and
PR4IVIDED FURTHER, that this obtiga#ion shall'be continuaus in natul•e alad
successive recaveries may be had liereon fnr successive breaches.
CITY OF FORT WORTH
STANDARA CONSTRUCT'ION SPECIFICATION DOCUMEN7'S
Revised Juty 1, 201 l
MSERIt2019, IS`Renewal
City Project. No. 102T96
0061 19-3
MAINTENANCE BOND
Page 3 of 3
1 IN WTTIV�SS WH�ItGOF, tlie Principal and tlie Surety have each SIGNED and SEALED this
2 instrumeiit by duly authorized agents and o�ce�•s on this the day of
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ATTEST:
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(Principal) Seci•etary Michele S. nkfor
Witness as to Principal
ATTEST:
(Surety) Secretary, ,� _' ,,;.,
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Witness as to Stu�ety John A. Miljer
PRiNCIPAL:
William J. Schultz, Inc. dba
Circle C Construc ' n Com an
BY; %�QA S�i
Signature
Teresa S. Skell President
Name and Title
Adciress: P. O. Box 40328
Fort Worth, TX 76140
SURETY:
Merchants B y�din Com an Mutual
BY:
Si�nature
Sheryl A. Klutts�Attorney-in-Fact
Name and Title
Address: 6700 Westown Parkway
West Des Moines. IA 50266
Telephone Number: 1-800-678-8171
*Note: If sigiied by an ofFicer of the 5urety Compaiiy, there must be oii file a cei�iified extract
from the by-laws showing that this person has authority to sign sucl� obligation. If
Surety's physical address is different fi�om its n�ailing address, both must be provided.
The date of the bond shall not be prior to tlie date the Cont�•act is awarded.
CTI'Y OF FORT WORTH
STANDAIZD CONSTRUCTION SPECIFICATION DOCUMENTS
Revised July 1, 2011
MSERR'L019, 1" Renewal
City Ptoject. No. 102196
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KnowAll Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of lowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually,
John A Miller; John R Stockton; Sheryl A Klutts
their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behaif of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding, Inc., on October 16, 2015.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shail have power and authority
to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed tnat the power and aut hority hereby given to the
Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State ofFlorida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonweaith of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 11th day of February , 2020 .
,�yyi�n�tyaa� s� ' ss
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.`oj�,�'d�p�R,4'�O�'� e �C��OQIP#?i� • ;�'9'*+ MERCHANTS BONDING COMPANY (MUTUAL)
'� � G �'� .'y ; � � � V 'ft,,�•;�„� y MERCHANT NATIONAL BONDING, INC.
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�°.���f/ � ' �' ��'Jt�•� '.;�� y�• l�,•' President
STATE OF IOWA ���'""�"''�, � � ""' �
COUNTY OF DA�LAS ss.
On this 11th day of February 2020 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
,�PR�A� s POLLY MASDN .
o � Commission Number 750576 �' �/V�g�.�p�...�
z°°°°'` My Commission Expires a��
� �o P� January 07, 2023
Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
i, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby
certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full
force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 1st day of December,2020.
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ERC TS
BONDING COMPANY,�
MERCHANTS BONDWG COMPANY (MUTiJAL) • MERCHANTS NATIONAL BONDING, INC.
P.O. Box 14498 � DES MOINES, IOWA 50306-3498 �(800) 678-8171 �(515) 243-3854 FAX
Please send all notices of claim on this bond to:
Merchants Bonding Company (Mutual) / Merchants National Bonding, Inc.
P.O. Box 14498
Des Moines, Iowa 50306-3498
(515) 243-8171
(800) 678-8171
Physical Address: 6700 Westown Parkway, West Des Moines, Iowa 50266
SUP 0073 TX (2/15)
Policy #CPP100051064 COMMERCIAL GENERAL LIABILITY
CGL 084 (10 13)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION
AGREEMENT WITH YOU - ONGOING OPERATIONS AND
PRODUCTS-COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE (OPTIONAL)
Name of Additional insured Persons or Organizations
(As required by written contract or agreement per Paragraph A. below.)
Locations of Covered Operations
(As per the written contract or agreement, provided the location is within the "coverage territory".)
(Information required to complete this Schedule, if not shown above, will be shown in the Declarations.)
A. Section 11— Who Is An Insured is amended to include as an additional insured:
1. Any person or organization for whom you are performing operations when you and such person or
organization have agreed in writing in a contract or agreement in effect during the term of this policy that
such person or organization be added as an additional insured on your policy; and
2. Any other person or organization you are required to add as an additional insured under the contract or
agreement described in Paragraph 1. above; and
3. The particular person or organization, if any, scheduled above.
Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury",
"property damage" or "personal and advertising injury" occurring after the execution of the contract or
agreement described in Paragraph 1. above and caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for
the additional insured; or
3. Your work" performed for the additional insured and included in the "products-completed operations
hazard" if such coverage is specifically required in the written contract or agreement.
CGL 084 (10 13) Includes copyrighted material of the Insurance Services Offices, Inc. with its permission. Page 1 of 3
Copyright 2013 FCCI Insurance Group.
COMMERCIAL GENERAL LIABILITY
CGL 084 (10 13)
However, the insurance afforded to such additional insured(s) described above:
1. Only applies to the extent permitted by law;
2. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured;
3. Will not be broader than that which is afforded to you under this policy; and
4. Nothing herein shall extend the term of this policy.
B. The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or
"personal and advertising injury" arising out of the rendering of, or the failure to render, any professional
architectural, engineering or surveying services, including:
1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
2. Supervisory, inspection, architectural or engineering activities.
C. This insurance is excess over any other valid and collectible insurance available to the additional insured
whether on a primary, excess, contingent or any other basis; unless the written contract or agreement
requires that this insurance be primary and non-contributory, in which case this insurance will be primary and
non-contributory relative to insurance on which the additional insured is a Named Insured.
D. With respect to the insurance afforded to these additional insureds, the following is added to Section III —
Limits of Insurance:
The most we wiil pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement described in Paragraph A.1.; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
E. Section IV — Commercial General Liability Conditions is amended as follows:
The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following
additional conditions applicable to the additional insured:
An additional insured under this endorsement must as soon as practicable:
1. Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this
insurance, and of any claim or "suit" that does result;
2. Send us copies of all legal papers received in connection with the claim or "suiY', cooperate with us in the
investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy
conditions; and
3. Tender the defense and indemnity of any claim or "suiY' to any provider of other insurance which would
cover the additional insured for a loss we cover under this endorsement and agree to make available all
such other insurance. However, this condition does not affect Paragraph C. above.
CGL 084 (10 13) Includes copyrighted material of the Insurance Services Offices, Inc. with its permission. Page 2 of 3
Copyright 2013 FCCI Insurance Group.
COMMERCIA� GENERAL LIABILITY
CGL 084 (10 13)
We have no duty to defend or indemnify an additional insured under this endorsement until we receive from
the additional insured written notice of a claim or "suiY'.
F. This endorsement does not apply to any additional insured or project that is specifically identified in any other
additional insured endorsement attached to the Commercial General Liability Coverage Form.
CGL 084 (10 13) Includes copyrighted material of the Insurance Services Offices, Inc. with its permission. Page 3 of 3
Copyright 2013 FCCI Insurance Group.
Policy #CPP100051064
. , • -� •- �: .•-
TABLE OF CONTENTS
DESCRIPTION
PAGE
Additional Insured Coverage ...................................................................................................................................... 9
BailBonds ................................................................................................................................................................... 9
BlanketWaiver of Subrogation ................................................................................................................................. 14
Bodilyinjury and Property Damage ........................................................................................................................... 1
Care, Custody or Control ............................................................................................................................................ 3
Contractors Errors and Omissions ............................................................................................................................. 6
Contractual Liability (Personal & Advertising Injury) .................................................................................................. 2
ElectronicData Liability .............................................................................................................................................. 1
GeneralLiability Conditions ...................................................................................................................................... 13
IncidentalMalpractice ................................................................................................................................................. 9
Insured........................................................................................................................................................................ 9
Limited Product Withdrawal Expense ........................................................................................................................ 3
Limitsof Insurance ................................................................................................................................................... 11
Lossof Earnings ......................................................................................................................................................... 9
LostKey Coverage ..................................................................................................................................................... 8
Newly Formed or Acquired Organizations ............................................................................................................... 11
Non-Owned Watercraft ............................................................................................................................................... 1
Property Damage Liability — Borrowed Equipment .................................................................................................... 1
TenanYs Property and Premises Rented To You ...................................................................................................... 8
VoluntaryProperty Damage ....................................................................................................................................... 2
Policy #CPP100051064 COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FIRST CHOICE CONTRACTORS LIABILITY ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
NOTE: The following are additions, replacements and amendments to the Commercial General Liability Coverage
Form, and will apply unless excluded by separate endorsement(s) to the Commercial General Liability Coverage Form.
The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended as follows:
SECTION I- COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE is amended as follows:
1. Extended "Property Damage"
Exciusion 2.a., Expected or Intended Injury, is replaced with the following:
a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This
exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable
force to protect persons or property.
2. Non-owned Watercraft
Exclusion 2.g. (2) (a) is replaced with the following:
(a) Less than 51 feet long; and
3. Property Damage Liability — Borrowed Equipment
The following is added to Exclusion 2.j. (4):
Paragraph (4) of this exclusion does not apply to "property damage" to borrowed equipment while at a
jobsite and not being used to perform operations. The most we will pay for "property damage" to any one
borrowed equipment item under this coverage is $25,000 per "occurrence". The insurance afforded under
this provision is excess over any other valid and collectible property insurance (including deductible)
available to the insured, whether primary, excess, contingent or on any other basis.
4. Limited Electronic Data Liability
Exclusion 2.p. is replaced with the following:
p. Electronic Data
Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or
inability to manipulate "electronic data" that does not result from physical injury to tangible property.
The most we will pay under Coverage A for "property damage" because of all loss of "electronic data"
arising out of any one "occurrence" is $10,000.
We have no duty to investigate or defend claims or "suits" covered by this Limited Electronic Data Liability
coverage.
The following definition is added to SECTION V— DEFINITIONS of the Coverage Form:
"Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted
to or from computer software (including systems and applications software), hard or floppy disks, CD-
ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically
controlled equipment.
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 1 of 14
Copyright 2015 FCCI Insurance Group
�
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
For purposes of this Limited Electronic Data Liability coverage, the definition of "Property Damage" in
SECTION V— DEFINITIONS of the Coverage Form is replaced by the following:
17. "Property damage" means:
a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss
of use shall be deemed to occur at the time of the physical injury that caused it;
b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed
to occur at the time of the "occurrence" that caused it;
c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly
manipulate "electronic data", resulting from physical injury to tangible property. All such loss of
"electronic data" shall be deemed to occur at the time of the "occurrence" that caused it.
For purposes of this insurance, "electronic data" is not tangible property.
SECTION 1— COVERAGES, COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY is amended
as follows:
Paragraph 2.e. Exclusions — the Contractual Liability Exclusion is deleted.
SECTION I— COVERAGES, the following coverages are added:
COVERAGE D. VOLUNTARY PROPERTY DAMAGE
1. Insuring Agreement
We will pay, at your request, for "property damage" caused by an "occurrence", to property of others
caused by you, or while in your possession, arising out of your business operations. The amount we will
pay for damages is described in SECTION ill LIMITS OF INSURANCE.
2. Exclusions
This insurance does not apply to:
"Property Damage" to:
a. Property at premises owned, rented, leased or occupied by you;
b. Property while in transit;
c. Property owned by, rented to, leased to, loaned to, borrowed by, or used by you;
d. Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those
premises;
e. Property caused by or arising out of the "products-completed operations hazard";
f. Motor vehicles;
g. "Your producY' arising out of it or any part of it; or
h. "Your work" arising out of it or any part of it.
3. Deductible
We will not pay for loss in any one "occurrence" until the amount of loss exceeds $250. We will then pay
the amount of loss in excess of $250 up to the applicable limit of insurance.
4. Cost Factor
In the event of a covered loss, you shall, if requested by us, replace the damaged property or furnish the
labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead
charges.
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 2 of 14
Copyright 2015 FCCI Insurance Group
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
The insurance afforded under COVERAGE D is excess over any other valid and collectibie property or inland
marine insurance (including the deductible applicable to the property or inland marine coverage) available to
you whether primary, excess, contingent or any other basis.
Coverage D covers unintentional damage or destruction, but does not cover disappearance, theft, or loss of
use.
The insurance under COVERAGE D does not apply if a loss is paid under COVERAGE E.
COVERAGE E. CARE, CUSTODY OR CONTROL
1. Insuring Agreement
We will pay those sums that the insured becomes legally obligated to pay as damages because of
"property damage" caused by an "occurrence", to property of others while in your care, custody, or control
or property of others as to which you are exercising physical control if the "property damage" arises out of
your business operations. The amount we will pay for damages is described in SECTION III LIMITS OF
INSURANCE.
2. Exclusions
This insurance does not apply to:
"Property Damage" to:
a. Property at premises owned, rented, leased or occupied by you;
b. Property while in transit;
c. Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those
premises;
d. Property caused by or arising out of the "products-compieted operations hazard";
e. Motor vehicles;
f. "Your product" arising out of it or any part of it; or
g. "Your work" arising out of it or any part of it.
3. Deductible
We will not pay for loss in any one "occurrence" until the amount of loss exceeds $250. We will then pay
the amount of loss in excess of $250 up to the applicable limit of insurance.
4. Cost Factor
In the event of a covered loss, you shall, if requested by us, replace the damaged property or furnish the
labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead
charges.
The insurance afforded under COVERAGE E is excess over any other valid and collectible property or inland
marine insurance (including the deductible applicable to the property or inland marine coverage) available to
you whether primary, excess, contingent or any other basis.
The insurance under COVERAGE E does not apply if a loss is paid under COVERAGE D.
COVERAGE F. LIMITED PRODUCT WITHDRAWAL EXPENSE
1. Insuring Agreement
a. If you are a"seller", we will reimburse you for "product withdrawal expenses" associated with "your
producY' incurred because of a"product withdrawal" to which this insurance applies.
The amount of such reimbursement is limited as described in SECTION III - LIMITS OF
INSURANCE. No other obligation or liability to pay sums or perform acts or services is covered.
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 3 of 14
Copyright 2015 FCCI Insurance Group
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
a. This insurance applies to a"product withdrawal" only if the "product withdrawal" is initiated in the
"coverage territory" during the policy period because:
(1) You determine that the "product withdrawal" is necessary; or
(2) An authorized government entity has ordered you to conduct a"product withdrawal".
c. We will reimburse only those "product withdrawal expenses" which are incurred and reported to us
within one year of the date the "product withdrawal" was initiated.
d. The initiation of a"product withdrawal" will be deemed to have been made only at the earliest of the
following times:
(1) When you have announced, in any manner, to the general public, your vendors or to your
employees (other than those employees directly involved in making the determination) your
decision to conduct a"product withdrawal" This applies regardless of whether the determination
to conduct a"product withdrawal" is made by you or is requested by a third party;
(2) When you received, either orally or in writing, notification of an order from an authorized
government entity to conduct a"product withdrawal; or
(3) When a third party has initiated a"product withdrawal" and you communicate agreement with the
"product withdrawal", or you announce to the general public, your vendors or to your employees
(other than those employees directly involved in making the determination) your decision to
participate in the "product withdrawal", whichever comes first.
e. "Product withdrawal expenses" incurred to withdraw "your products" which contain:
(1) The same "defect" will be deemed to have arisen out of the same "product withdrawal' ; or
(2) A different "defecY' will be deemed to have arisen out of a separate "product withdrawal" if newly
determined or ordered in accordance with paragraph 1.b of this coverage.
2. Exclusions
This insurance does not apply to "product withdrawal" expenses" arising out of:
a. Any "product withdrawal" initiated due to:
(1) The failure of "your products" to accomplish their intended purpose, including any breach of
warranty of fitness, whether written or implied. This exclusion does not apply if such failure has
caused or is reasonably expected to cause "bodily injury" or physical damage to tangible
property.
(2) Copyright, patent, trade secret or trademark infringements;
(3) Transformation of a chemical nature, deterioration or decomposition of "your product", except if it
is caused by:
(a) An error in manufacturing, design, processing or transportation of "your producY ; or
(b) "Product tampering".
(4) Expiration of the designated shelf life of "your product".
b. A"product withdrawal", initiated because of a"defecY' in "your producY' known to exist by the Named
Insured or the Named Insured's "executive officers", prior to the inception date of this Coverage Part
or prior to the time "your producY' leaves your control or possession.
c. Recall of any specific products for which "bodily injury" or "property damage" is excluded under
Coverage A- Bodily Injury And Property Damage Liability by endorsement.
d. Recall of "your products" which have been banned from the market by an authorized government
entity prior to the policy period.
e. The defense of a claim or "suiY' against you for "product withdrawal expenses".
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 4 of 14
Copyright 2015 FCCI Insurance Group
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
3. For the purposes of the insurance afforded under COVERAGE F, the following is added to 2. Duties In
The Event Of Occurrence, Offense, Claim Or Suit Condition under SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS:
e. Duties In The Event Of A"Defect" Or A"Product Withdrawal"
(1) You must see to it that we are notified as soon as practicable of any actual, suspected or
threatened "defect" in "your products", or any governmental investigation, that may result in a
"product withdrawal". To the extent possible, notice should include:
(a) How, when and where the "defecY' was discovered;
(b) The names and addresses of any injured persons and witnesses; and
(c) The nature, location and circumstances of any injury or damage arising out of use or
consumption of "your product".
(2) If a"product withdrawal" is initiated, you must:
(a) Immediately record the specifics of the "product withdrawal" and the date it was initiated;
(b) Send us written notice of the "product withdrawal" as soon as practicable; and
(c) Not release, consign, ship or distribute by any other method, any product, or like or similar
products, with an actual, suspected or threatened defect.
(3) You and any other involved insured must:
(a) Immediately send us copies of pertinent correspondence received in connection with the
"product withdrawal' ;
(b) Authorize us to obtain records and other information; and
(c) Cooperate with us in our investigation of the "product withdrawal".
4. For the purposes of this Coverage F, the following definitions are added to the Definitions Section:
a. "DefecY' means a defect, deficiency or inadequacy that creates a dangerous condition.
b. "Product tampering" is an act of intentional alteration of "your producY' which may cause or has
caused "bodily injury" or physical injury to tangible property.
When "product tampering" is known, suspected or threatened, a"product withdrawal" will not be
limited to those batches of "your product" which are known or suspected to have been tampered with.
c. "Product withdrawal" means the recall or withdrawal of "your products", or products which contain
"your products", from the market or from use, by any other person or organization, because of a
known or suspected "defect" in "your producY', or a known or suspected "product tampering", which
has caused or is reasonably expected to cause "bodily injury" or physical injury to tangible property.
d. "Product withdrawal expenses" means those reasonable and necessary extra expenses, listed below
paid and directly related to a"product withdrawal":
(1) Costs of notification;
(2) Costs of stationery, envelopes, production of announcements and postage or facsimiles;
(3) Costs of overtime paid to your regular non-salaried employees and costs incurred by your
employees, including costs of transportation and accommodations;
(4) Costs of computer time;
(5) Costs of hiring independent contractors and other temporary employees;
(6) Costs of transportation, shipping or packaging;
(7) Costs of warehouse or storage space; or
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 5 of 14
Copyright 2015 FCCI Insurance Group
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
(8) Costs of proper disposal of "your products", or products that contain "your products", that cannot
be reused, not exceeding your purchase price or your cost to produce the products; but "product
withdrawal expenses" does not include costs of the replacement, repair or redesign of "your
producY', or the costs of regaining your market share, goodwill, revenue or profit.
e. "Seller" means a person or organization that manufactures, sells or distributes goods or products.
"Seller" does not include a"contractor" as defined elsewhere in this endorsement.
The insurance under COVERAGE F does not apply if a loss is paid under COVERAGE G.
COVERAGE G. CONTRACTORS ERRORS AND OMISSIONS
1. Insuring Agreement
If you are a"contractor", we will pay those sums that you become legally obligated to pay as damages
because of "property damage" to "your producY', "your work" or "impaired property", due to faulty
workmanship, material or design, or products including consequential loss, to which this insurance
applies. The damages must have resulted from your negligent act, error or omission while acting in your
business capacity as a contractor or subcontractor or from a defect in material or a product sold or
installed by you while acting in this capacity. The amount we will pay for damages is described in
SECTION III LIMITS OF INSURANCE.
We have no duty to investigate or defend claims or "suits" covered by this Contractors Errors or
Omissions coverage.
This coverage applies only if the "property damage" occurs in the "coverage territory" during the policy
period.
This coverage does not apply to additional insureds, if any.
Supplementary Payments — Coverage A and B do not apply to Coverage G. Contractors Errors and
Omissions.
2. Exclusions
This insurance does not apply to:
a. "Bodily injury" or "personal and advertising injury".
b. Liability or penalties arising from a delay or failure to complete a contract or project, or to complete a
contract or project on time.
c. Liability because of an error or omission:
(1) In the preparation of estimates or job costs;
(2) Where cost estimates are exceeded;
(3) In the preparation of estimates of profit or return on capital;
(4) In advising or failure to advise on financing of the work or project; or
(5) In advising or failing to advise on any legal work, title checks, form of insurance or suretyship.
d. Any liability which arises out of any actual or alleged infringement of copyright or trademark or trade dress
or patent, unfair competition or piracy, or theft or wrongful taking of concepts or intellectual property.
e. Any liability for damages:
(1) From the intentional dishonest, fraudulent, malicious or criminal acts of the Named Insured, or by
any partner, member of a limited liability company, or executive officer, or at the direction of any
of them; or
(2) Which is in fact expected or intended by the insured, even if the injury or damage is of a different
degree or type than actually expected or intended.
CGL 088 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 6 of 14
Copyright 2015 FCCI Insurance Group
COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
f. Any liability arising out of manufacturer's warranties or guarantees whether express or implied.
g. Any liability arising from "property damage" to property owned by, rented or leased to the insured.
h. Any liability incurred or "property damage" which occurs, in whole or in part, before you have
completed "your work." "Your work" will be deemed completed at the earliest of the following times:
(1) When all of the work called for in your contract or work order has been completed;
(2) When all the work to be done at the job site has been completed if your contract calls for work at
more than one job site; or
(3) When that part of the work done at a job site has been put to its intended use by any person or
organization other than another contractor or subcontractor working on the same project.
Work that may need service or maintenance, correction, repair or replacement, but which is otherwise
complete, will be treated as complete.
i. Any liability arising from "property damage" to products that are still in your physical possession.
j. Any liability arising out of the rendering of or failure to render any professional services by you or on
your behalf, but only with respect to either or both of the following operations:
(1) Providing engineering, architectural or surveying services to others; and
(2) Providing or hiring independent professionals to provide engineering, architectural or surveying
services in connection with construction work you perform.
Professional services include the preparing, approving or failing to prepare or approve, maps, shop
drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications.
Professional services also include supervisory or inspection activities performed as part of any related
architectural or engineering activities.
But, professional services do not include services within construction means, methods, techniques,
sequences and procedures employed by you in connection with construction work you perform.
k. Your loss of profit or expected profit and any liability arising therefrom.
I. "Property damage" to property other than "your product," "your work" or "impaired property."
m. Any liability arising from claims or "suits" where the right of action against the insured has been
relinquished or waived.
n. Any liability for "property damage" to "your work" if the damaged work or the work out of which the
damage arises was performed on your behalf by a subcontractor.
o. Any liability arising from the substitution of a material or product for one specified on blueprints, work
orders, contracts or engineering specifications unless there has been written authorization, or unless
the blueprints, work orders, contracts or engineering specifications were written by you, and you have
authorized the changes.
p. Liability of others assumed by the insured under any contract or agreement, whether oral or in writing.
This exclusion does not apply to liability for damages that the insured would have in the absence of
the contract or agreement.
3. For the purposes of Coverage G, the following definition is added to the Definitions section:
a. "Contractor" means a person or organization engaged in activities of building, clearing, filing,
excavating or improvement in the size, use or appearance of any structure or land. "Contractor" does
not include a"seller" as defined elsewhere in this endorsement.
4. Deductible
We will not pay for loss in any one "occurrence" until the amount of loss exceeds $250. The limits of
insurance will not be reduced by the application of the deductible amount.
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COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
We may pay any part or all of the deductible amount to effect settlement of any claim or "suiY', and upon
notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as
has been paid by us.
5. Cost Factor
In the event of a covered loss, you shall, if requested by us, replace the damaged property or furnish the
labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead
charges.
The insurance under COVERAGE G does not apply if a loss is paid under COVERAGE F.
COVERAGE H. LOST KEY COVERAGE
1. Insuring Agreement
We will pay those sums, subject to the limits of liability described in SECTION III LIMITS OF INSURANCE
in this endorsement and the deductible shown below, that you become legally obligated to pay as
damages caused by an "occurrence" and due to the loss or mysterious disappearance of keys entrusted
to or in the care, custody or control of you or your "employees" or anyone acting on your behalf. The
damages covered by this endorsement are limited to the:
a. Actual cost of the keys;
b. Cost to adjust locks to accept new keys; or
c. Cost of new locks, if required, including the cost of installation.
2. Exclusions
This insurance does not apply to:
a. Keys owned by any insured, employees of any insured, or anyone acting on behalf of any insured;
b. Any resulting loss of use; or
c. Any of the following acts by any insured, employees of any insured, or anyone acting on behalf of any
insured:
1) Misappropriation;
2) Concealment;
3) Conversion;
4) Fraud; or
5) Dishonesty.
3. Deductible
We will not pay for loss in any one "occurrence" until the amount of loss exceeds $1,000. The limits of
insurance will not be reduced by the application of the deductible amount.
We may pay any part or all of the deductible amount to effect settlement of any claim or "suiY' and, upon
notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as
has been paid by us.
EXPANDED COVERAGE FOR TENANT'S PROPERTY AND PREMISES RENTED TO YOU
The first paragraph after subparagraph (6) in Exclusion j., Damage to Property is amended to read as follows:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire)
to premises, including the contents of such premises, rented to you. A separate limit of insurance applies
to Damage To Premises Rented To You as described in Section III — Limits Of Insurance.
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COMMERCIAL GENERAL LIABILITY
CGL 088 (01 15)
SECTION I- COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGE A and B is amended as follows:
All references to SUPPLEMENTARY PAYMENTS — COVERAGES A and B are amended to SUPPLEMENTARY
PAYMENTS — COVERAGES A, B, D, E, G, and H.
1. Cost of Bail Bonds
Paragraph 1.b. is replaced with the following:
b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use
of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.
2. Loss of Earnings
Paragraph 1.d. is replaced with the following:
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense
of the claim or "suiY', including actual loss of earnings up to $500 a day because of time off from work.
SECTION II — WHO IS AN INSURED is amended as follows:
1. Incidental Malpractice
Paragraph 2.a.(1)(d) is replaced with the following:
(d) Arising out of his or her providing or failing to provide professional health care services. However, this
exclusion does not apply to a nurse, emergency medical technician or paramedic employed by you to
provide medical services, unless:
(i) You are engaged in the occupation or business of providing or offering medical, surgical, dental, x-ray
or nursing services, treatment, advice or instruction; or
(ii) The "employee" has another insurance that would also cover claims arising under this provision,
whether the other insurance is primary, excess, contingent or on any other basis.
2. Broadened Who Is An Insured
The following are added to Paragraph 2.:
Subsidiaries
e. Your subsidiaries if:
(1) They are legally incorporated entities; and
(2) You own more than 50% of the voting stock in such subsidiaries as of the effective date of this policy.
If such subsidiaries are not shown in the Deciarations, you must report them to us within 180 days of
the inception of your original policy.
Additional Insureds
f. Any person or organization described in paragraphs g. through k. below whom you are required to add as
an additional insured on this policy under a written contract or agreement in effect during the term of this
policy, provided the written contract or agreement was executed prior to the "bodily injury", "property
damage" or "personal and advertising injury" for which the additional insured seeks coverage.
However, the insurance afforded to such additional insured(s):
(1) Only applies to the extent permitted by law;
(2) Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured;
(3) Will not be broader than that which is afforded to you under this policy;
(4) Is subject to the conditions described in paragraphs g. through k. below; and
(5) Nothing herein shall extend the term of this policy.
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g. Owner, Lessor or Manager of Premises
If the additional insured is an owner, lessor or manager of premises, such person or organization shall be
covered only with respect to liability arising out of the ownership, maintenance or use of that part of any
premises leased to you and subject to the following additional exclusions:
(1) Any "occurrence" that takes place after you cease to occupy those premises; or
(2) Structural alterations, new construction or demolition operations performed by or on behalf of such
person or organization.
h. State or Governmental Agency or Subdivision or Political Subdivision — Permits or Authorizations
If the additional insured is the state or any political subdivision, the state or political subdivision shall be
covered only with respect to operations performed by you or on your behalf for which the state or political
subdivision has issued a permit or authorization. This insurance does not apply to:
(1) "Bodily injury", "property damage", or "personal and advertising injury" arising out of operations
performed for the federal government, state or municipality; or
(2) "Bodily injury" or "property damage" included within the "products-completed operations hazard".
i. Lessor of Leased Equipment
If the additional insured is a lessor of leased equipment, such lessor shall be covered only with respect to
liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in
part, by your maintenance, operation or use of equipment leased to you by such person(s) or
organization(s). With respect to the insurance afforded to these additional insureds, this insurance does
not apply to any "occurrence" which takes place after the equipment lease expires.
j. Mortgagee, Assignee, or Receiver
if the additional Insured is a mortgagee, assignee, or receiver of premises, such mortgagee, assignee or
receiver of premises is an additional insured only with respect to their liability as mortgagee, assignee, or
receiver and arising out of the ownership, maintenance, or use of the premises by you. This insurance
does not apply to structural alterations, new construction and demolition operations performed by or for
that person or organization.
k. Vendor
If the additional insured is a vendor, such vendor is an additional insured only with respect to "bodily
injury" or "property damage" caused by "your products" which are distributed or sold in the regular course
of the vendor's business, subject to the following additional exclusions:
(1) The insurance afforded to the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason
of the assumption of liability in a contract or agreement. This exclusion does not apply to liability
for damages that the vendor would have in absence of the contract or agreement.
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in "your producY' made intentionally by the vendor;
(d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the manufacturer, and then repackaged in the original
container;
(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed
to make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products;
(f) Demonstration, installation, servicing or repair operations, except such operations performed at
the vendor's premises in connection with the sale of the product;
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(g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor; or
(h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own
acts or omissions or those of its own acts or omissions or those of its employees or anyone else
acting on its behalf. However, this exclusion does not apply to:
The exceptions contained in Subparagraphs d. or f.; or
Such inspections, adjustments, tests or servicing as the vendor has agreed to make or
normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products.
(2) This insurance does not apply to any insured person or organization, from whom you have acquired such
products, or any ingredient, part or container, entering into, accompanying or containing such products.
3. Newly Formed or Acquired Organizations
Paragraph 3. is amended as follows:
a. Coverage under this provision is afforded until the end of the policy period.
d. Coverage A does not apply to product recall expense arising out of any withdrawal or recall that occurred
before you acquired or formed the organization.
SECTION III — LIMITS OF INSURANCE is amended as follows:
1. Paragraph 2. is replaced with the following:
2. The General Aggregate Limit is the most we will pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of "bodily injury" or "property damage"
included in the "products-completed operations hazard";
c. Damages under Coverage B;
d. Voluntary "property damage" payments under Coverage D;
e. Care, Custody or Control damages under Coverage E.; and
f. Lost Key Coverage under Coverage H.
2. Paragraph 5. is repiaced with the following:
5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will
pay for the sum of:
a. Damages under Coverage A;
b. Medical expenses under Coverage C;
c. Voluntary "property damage" payments under Coverage D;
d. Care, Custody or Control damages under Coverage E;
e. Limited Product Withdrawal Expense under Coverage F;
f. Contractors Errors and Omissions under Coverage G.; and,
g. Lost Key Coverage under Coverage H.
because of all "bodily injury" and "property damage" arising out of any one "occurrence".
3. Paragraph 6. is replaced with the following:
6. Subject to Paragraph 5. above the Damage To Premises Rented To You Limit is the most we will pay
under Coverage A for damages because of "property damage" to any one premises, while rented to you,
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CGL 088 (01 15)
or in the case of damage by fire or explosion, while rented to you or temporarily occupied by you with
permission of the owner.
The Damage to Premises Rented to You Limit is the higher of the Each Occurrence Limit shown in the
Declarations or the amount shown in the Declarations as Damage To Premises Rented To You Limit.
4. Paragraph 7. is replaced with the following:
7. Subject to Paragraph 5. above, the higher of $10,000 or the Medical Expense Limit shown in the
Declarations is the most we will pay under Coverage C for ail medical expenses because of "bodily injury"
sustained by any one person.
5. Paragraph 8. is added as follows:
8. Subject to Paragraph 5. above, the most we will pay under Coverage D. Voluntary Property Damage for
loss arising out of any one "occurrence" is $1,500. The most we will pay in any one-policy period,
regardless of the number of claims made or suits brought, is $3,000.
6. Paragraph 9. is added as follows:
9. Subject to Paragraph 5. above, the most we will pay under Coverage E. Care, Custody or Control for
"property damage" arising out of any one "occurrence" is $1,000. The most we will pay in any one-policy
period, regardless of the number of claims made or suits brought, is $5,000.
7. Paragraph 10. is added as follows:
10. Subject to Paragraph 5. above, the most we will pay under Coverage F. Limited Product Withdrawal
Expense for "product withdrawal expenses" in any one-policy period, regardless of the number of
insureds, "product withdrawals" initiated or number of "your products" withdrawn is $10,000.
8. Paragraph 11. is added as follows:
11. Subject to Paragraph 5. above, the most we will pay under Coverage G. Contractors Errors and
Omissions for damage in any one-policy period, regardless of the number of insureds, claims or "suits"
brought, or persons or organizations making claim or bringing "suits" is $10,000.
For errors in contract or job specifications or in recommendations of products or materials to be used, this
policy will not pay for additional costs of products and materials to be used that would not have been
incurred had the correct recommendations or specifications been made.
9. Paragraph 12. is added as follows:
12. Subject to Paragraph 5. above, the most we will pay under Coverage H., Lost Key Coverage for damages
arising out of any one occurrence is $50,000.
10. Paragraph 13. is added as follows:
13. The General Aggregate Limit applies separately to:
a. Each of your projects away from premises owned by or rented to you; or
b. Each "location" owned by or rented to you.
"Location" as used in this paragraph means premises involving the same or connecting lots, or premises
whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad.
11. Paragraph 14. is added as follows:
14. With respect to the insurance afforded to any additional insured provided coverage under this
endorsement:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay
on behalf of the additional insured is the amount of insurance:
a. Required by the contract or agreement; or
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b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:
1. Subparagraph 2.a. of Duties In The Event Of Occurrence, Offense, Claim, or Suit is replaced with the
following:
a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may
result in a claim. This requirement applies only when the "occurrence" or offense is known to the
following:
(1) An individual who is the sole owner;
(2) A partner, if you are a partnership or joint venture;
(3) An "executive officer" or insurance manager, if you are a corporation;
(4) A manager, if you are a limited liability company;
(5) A person or organization having proper temporary custody of your property if you die;
(6) The legal representative of you if you die; or
(7) A person (other than an "employee") or an organization while acting as your real estate manager.
To the extent possible, notice should include:
(1) How, when and where the "occurrence" or offense took place;
(2) The names and addresses of any injured persons and witnesses; and
(3) The nature and location of any injury or damage arising out of the "occurrence" or offense.
2. The following is added to Subparagraph 2.b. of Duties In The Event Of Occurrence, Offense, Claim, or
Suit:
The requirement in 2.b.applies only when the "occurrence" or offense is known to the following:
(1) An individual who is the sole owner;
(2) A partner or insurance manager, if you are a partnership or joint venture;
(3) An "executive officer" or insurance manager, if you are a corporation;
(4) A manager or insurance manager, if you are a limited liability company;
(5) Your officials, trustees, board members or insurance manager, if you are a not-for-profit organization;
(6) A person or organization having proper temporary custody of your property if you die;
(7) The legal representative of you if you die; or
(8) A person (other than an "employee") or an organization while acting as your real estate manager.
3. The following is added to paragraph 2. of Duties in the Event of Occurrence, Offense, Claim or Suit:
e. If you report an "occurrence" to your workers compensation carrier that develops into a liability claim for
which coverage is provided by the Coverage Form, failure to report such an "occurrence" to us at the time
of the "occurrence" shall not be deemed a violation of paragraphs a., b., and c. above. However, you
shall give written notice of this "occurrence" to us as soon as you become aware that this "occurrence"
may be a liability claim rather than a workers compensation claim.
4. Paragraph 6. is replaced with the following:
6. Representations
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By accepting this policy, you agree:
a. The statements in the Declarations are accurate and complete;
b. Those statements are based upon representations you made to us; and
c. We have issued this policy in reliance upon your representations.
Any error or omission in the description of, or failure to completely describe or disclose any premises,
operations or products intended to be covered by the Coverage Form will not invalidate or affect coverage
for those premises, operations or products, provided such error or omission or failure to completely
describe or disclose premises, operations or products was not intentional.
You must report such error or omission to us as soon as practicable after its discovery. However, this
provision does not affect our right to collect additional premium charges or exercise our right of
cancellation or nonrenewal.
5. The following is added to paragraph 8. Transfer Of Rights Of Recovery Against Others To Us:
However, we waive any right of recovery we may have because of payments we make for injury or
damage arising out of your ongoing operations or "your work" included in the "products-completed
operations hazard" under the following conditions:
a) Only when you have agreed in writing to waive such rights of recovery in a contract or agreement;
b) Only as to the person/entity as to whom you are required by the contract to waive rights of recovery;
and
c) Only if the contract or agreement is in effect during the term of this policy, and was executed by you
prior to the loss.
6. Paragraph 10. is added as follows:
10. Liberalization
If we revise this Coverage Form to provide more coverage without additional premium charge, your
policy will automatically provide the additional coverage as of the day the revision is effective in the
applicable state(s).
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Policy #CAA100051065
COMMERCIAL AUTO
CAU 058 (05 19)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO FIRST CHOICE COVERAGE ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
NOTE: The foilowing are additions, replacements and amendments to the Business Auto Coverage Form, and
will apply unless excluded by separate endorsement(s) to the Business Auto Coverage Form.
With respect to coverages provided by this endorsement, the provisions of the Business Auto Coverage Form
apply unless modified by this endorsement.
The Business Auto Coverage Form is amended as follows:
SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended as follows:
A. Paragraph 1. Who Is An Insured in section A. Coverage is amended by the addition of the following:
d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the
effective date of this coverage form. However, "insured" does not include any subsidiary that is an
"insured" under any other liability policy or would be an "insured" under such a policy but for its
termination or the exhaustion of its limits of insurance. In order for such subsidiaries to be considered
insured under this policy, you must notify us of such subsidiaries within 60 days of policy effective date.
e. Any organization you newly acquire or form during the policy period, other than a partnership or joint
venture, and over which you maintain sole ownership or a majority interest. However, coverage under
this provision:
(1) Does not apply if the organization you acquire or form is an "insured" under another liability policy
or would be an "insured" under such a policy but for its termination or the exhaustion of its limits of
insurance;
(2) Does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed
the organization; and
(3) Is afforded only for the first 90 days after you acquire or form the organization or until the end of the
policy period, whichever comes first.
f. Any person or organization who is required under a written contract or agreement between you and that
person or organization, that is signed and executed by you before the "bodily injury" or "property
damage" occurs and that is in effect during the policy period, to be named as an additional insured is
an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the
extent that person or organization qualifies as an "insured" under the Who Is An Insured provision
contained in Section II.
g. Any "employee" of yours using:
(1) a covered "auto" you do not own, hire or borrow, or a covered "auto" not owned by an "employee"
or a member of his or her household, while performing duties related to the conduct of your
business or your personal affairs; or
(2) an "auto" hired or rented under a contract or agreement in that "employee's" name, with your
permission, while performing duties related to the conduct of your business. However, your
"employee" does not qualify as an insured under this paragraph (2) while using a covered "auto"
rented from you or from any member of the "employee's" household
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CAU 058 (05 19)
h. Your members, if you are a limited liability company, while using a covered "auto" you do not own, hire
or borrow, while performing duties related to the conduct of your business or your personal affairs.
B. Paragraphs (2) and (4) under section 2. Coverage E�ctensions, a. Supplementary Payments are deleted
and replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of an
"accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" solely at our request, including actual loss of
earnings up to $500 a day because of time off from work.
C. Paragraph 5. under section B. Exclusions is deleted and replaced by the following:
5. Fellow Employee
"Bodily injury" to:
a. Any fellow "employee" of the "insured" arising out of and in the course of a fellow "employee's"
employment or while performing duties related to the conduct of your business. However, this
exciusion does not apply to your "employees" that are officers or managers if the "bodily injury"
results from the use of a covered "auto" you own, hire or borrow. Coverage is excess over any other
collectible insurance; or
b. The spouse, child, parent, brother or sister of that fellow "employee" as a consequence of Paragraph
a. above.
SECTION III — PHYSICAL DAMAGE COVERAGE is amended as follows:
A. Paragraph 4. Coverage Extensions under section A. Coverage is deleted and replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We wiil pay up to $50 per day to a total maximum of $1,500 for temporary transportation expense incurred
by you due to covered loss to any covered auto. We will pay only for those covered "autos" for which you
carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary
transportation expenses incurred during the period beginning 24 hours after a loss and ending, regardless
of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss".
b. Loss of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally
responsible to pay for �oss of use of a vehicle rented or hired without a driver under a written rental
contract or agreement. We will pay for loss of use expenses if caused by:
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for
hired "autos";
(2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage
is provided for hired "autos'; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for hired "autos".
However, the most we will pay for any expenses for loss of use to any one vehicle is $75 per day, to a
total maximum of $1,500.
B. The following is added to paragraph 4. Coverage Extensions under section A. Coverage:
c. Fire Department Service Charge
When a fire department is called to save or protect a covered "auto", its equipment, its contents, or
occupants from a covered cause of loss, we will pay up to $1,000 for your liability for fire department
service charges assumed by contractor or agreement prior to loss.
No deductible applies to this additional coverage.
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CAU 058 (05 19)
d. Auto Loan/Lease Gap Coverage
The following provisions apply:
(1) If a long term leased "auto", under an original lease agreement, is a covered "auto" under this
coverage form and the lessor of the covered "auto" is named as an additional insured under this
policy, in the event of a total loss to the leased covered "auto", we will pay any unpaid amount
due on the lease, less the amount paid under the Physicai Damage Coverage Section of the
policy; and less any:
(a) Overdue lease or loan payments including penalties, interest, or other charges resuiting from
overdue payments at the time of the "loss";
(b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high
mileage;
(c) Security deposits not refunded by the lessor;
(d) Costs for extended warranties, Credit Life Insurance, Health Accident or Disability Insurance
purchased with the loan or lease; and
(e) Carry-over balances from previous loans or leases.
(2) If an owned "auto" is a covered "auto" under this coverage form and the loss payee of the
covered "auto" is named a loss payee under this policy, in the event of a total loss to the covered
"auto", we will pay any unpaid amount due on the loan, less the amount paid under the Physical
Damage Coverage Section of the policy; and less any;
(a) Overdue loan payments at the time of the "loss";
(b) Costs for extended warranties, Credit Life Insurance, Health Accident or Disability Insurance
purchased with the loan; and
(c) Carry-over balances from previous loans.
C. Paragraph 3. under section B. Exclusions is deleted and replaced by the following:
3. We will not pay for "loss" due and confined to:
a. Wear and tear, freezing, mechanical or electrical breakdown
b. Blowouts, punctures or other road damage to tires
This exclusion does not apply to such "loss" resulting from the total theft of a covered "auto".
However, this exclusion does not include the discharge of an airbag in a covered "auto" you own that
inflates due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b and A.1.c.but only:
a. If that "auto" is a covered "auto" for Comprehensive Coverage under this policy;
b. The airbags are not covered under any warranty; and
c. The airbags were not intentionally inflated
We will pay up to a maximum of $1,000 for any one "loss".
D. Section D. Deductible is deleted and replaced by the following:
D. Deductible
For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property
will be reduced by the applicable deductible shown in the Declarations subject to the following:
Any Comprehensive Coverage deductible shown in the Declarations does not apply to:
(1) "Loss" caused by fire or lightning; and
(2) "Loss" arising out of theft of your vehicle if your vehicle is equipped with an active GPS tracking system.
CAU 058 (05 19) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 3 of 4
Copyright 2018 FCCI Insurance Group.
COMMERCIAL AUTO
CAU 058 (05 19)
(3) Glass damage if repaired rather than replaced.
SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows:
A. The following is added to paragraph a. under section A. Loss Conditions, 2. Duties in the Event of
Accident, Claim, Suit or Loss:
This duty applies when the "accident", claim, "suit" or "loss" is first known to:
(a) You, if you are an individuai;
(b) A partner, if you are a partnership;
(c) An executive officer or insurance manager, if you are a corporation; or
(d) A member or manager, if you are a limited liability company.
B. Condition 5. Transfer of Rights of Recovery against Others to Us under section A. Loss Conditions is
deleted and replaced by the foilowing:
5. Transfer of Rights of Recovery against Others to Us
If a person or organization to or for whom we make payment under this coverage form has rights to
recover damages from another, those rights are transferred to us. That person or organization must do
everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them.
However, if the insured has waived rights to recover through a written contract, or if your work was
commenced under a letter of intent or work order, subject to a subsequent reduction in writing of such a
waiver with customers whose customary contracts require a waiver, we waive any right of recovery we
may have under this coverage form.
C. The following is added to Condition 2. Concealment, Misrepresentation or Fraud under section B. General
Conditions:
However, if you unintentionally fail to disclose any hazards at the inception of your policy, we will not deny
coverage under this coverage form because of such failure. This provision does not affect our right to
collect additional premium or exercise our right of cancellation or non-renewal.
D. Paragraph b. of Condition 5. Other Insurance under section B. General Conditions is deleted and replaced
by the following:
b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own;
(1) Any covered "auto" you lease, hire, rent or borrow; and
(2) Any covered "auto" hired or rented by your "employee" under a contract in that individual
"employee's" name, with your permission, while performing duties related to the conduct of your
business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a
covered "auto", nor is any "auto" you hire from any of your "employees", partners (if you are a
partnership), members (if you are a limited liability company), or members of their households.
CAU 058 (05 19) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 4 of 4
Copyright 2018 FCCI Insurance Group.
Policy #CAA100051065 COMMERCIAL AUTOMOBILE
CAU 082 (01 15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTOMATIC INSURED - BUSINESS AUTO POLICY
PRIMARY/NON-CONTRIBUTING WHEN REQUIRED BY CONTRACT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
This endorsement is subject to the terms, conditions, exclusions and any other provisions of the BUSINESS
AUTO COVERAGE FORM or any endorsement attached thereto unless changes or additions are indicated
below.
For the purpose of this endorsement, Section II.A.1. Who Is An Insured is amended by adding the following:
1. Any person or organization when you and such person have agreed in writing in a contract signed and
executed by you prior to the loss for which coverage is sought, that such person or organization be added
as an "insured" on your auto policy. Such person or organization shall be an "insured" to the extent your
negligent actions or omissions impose liability on such "insured" without fault on its part.
2. This insurance is primary and non-contributory to other liability coverages of the person or organization
being added to this policy as an "insured" when so required in a written contract or agreement that is
executed prior to the loss for which coverage is sought.
CAU 082 (01 15) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 1 of 1
Copyright 2015 FCCI Insurance Group.
�
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WORKERS' COMPENSATION INSURANCE
WORKERS' COMPENSATION AND WC 42 O3 O4 B
EMPLOYERS LIABILITY POLICY Insured copy
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the
Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury
arising out of the operations described in the schedule where you are required by a written contract to obtain this waiver
from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1. ( ) Specific Waiver
Name of person or organization
(X) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.
2. Operations: All Texas operations
3. Premium:
The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll in connection
with work perFormed for the above person(s) or organization(s) arising out of the operations described.
4. Advance Premium: Included, see Information Page
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on 8/12/20 at 12:01 a.m. standard time, forms a part of:
Policy no. 0002051085 of Texas Mutual Insurance Company effective on 8/12/20
Issued to: WILLIAM J SCHULTZ INC
DBA: CIRCLE C CONSTRUCTION COMPANY
This is not a bill
NCCI Carrier Code: 29939
�'` ji/' 4�,
Authorized representative
8/11/20
PO Box 12058, Austin, TX 78711-2058
1 of 1 texasmutual.com �(800) 859-5995 � Fax (800) 359-0650 WC 42 03 04 B